Faculty of Health Sciences

Antibiotic crisis a global threat

Broadly speaking, the bacteria in a hospital in Vietnam are the same as those in Sweden. Yet while Swedish doctors can so far eliminate most infections, for the Vietnamese it is a battle against the odds due to the fact that half or more of the bacteria cannot be eradicated because they are resistant to antibiotics.

One antibiotic preparation after another ceases to work and global health care risks are being rocked to its foundations.

“This is a frightening development. Bacteria know no borders, yet we have to try to remain optimistic,” says Håkan Hanberger, chief physician and professor of Infectious Diseases at LiU, who has worked for many years as an expert in antibiotics issues.

Along with his research colleagues Magnus Johansson and Ulf Rydell, Hanberger has just put the finishing touches to a report to be presented at the 22nd European Congress of Clinical Microbiology and Infectious Diseases in London in March 2012. It shows, in cold hard figures, the catastrophic situation in intensive care at four hospitals in the formerly war-torn country, now a rapidly growing economy.

All the bacteria groups researched were highly resistant to five of the six available antibiotics. The worst example was the common hospital bacteria Acinetobacter, fatally dangerous for patients with compromised immune defences. Up to 71% of them were resistant, a figure at least ten times as high as in Swedish intensive care units.

“When more than half of the bacteria is resistant, it’s difficult for doctors to do the right thing. But there has to be a threshold to cross before resorting to the last preparation that works,” Hanberger says.

What is the right thing to do? Coming up with proposals for evidence-based efforts is one of the goals of the project, run jointly by the Swedish researchers and their Vietnamese colleagues. One point deals with formulating treatment strategies and carefully following up on the effects. Another one, which may seem obvious, is keeping the hospitals clean.

The critical development in inpatient care is a mirror image of the community outside the hospital walls. The more antibiotics are distributed, the more resistance increases. In many countries around the globe, broad-spectrum Antibiotics can be bought at pharmacies without a prescription. This is not the case in Sweden. Instead, we take a detour to the health care centre. In the East Swedish province of Östergötland, regional doctors write out 350 prescriptions per thousand residents annually.

According to the national goal, the number of prescriptions should be brought down to 250, which no Swedish county council has yet achieved.

The most common diagnoses are infections in airways and the urinary tract. The difference between various health care centres is great. One study in Östergötland looked into the prescription of a preparation for urinary tract infections. At one popular health care centre, it was prescribed for 14% of diagnoses, compared with 2% at the most restrictive centre.

“It is possible to put the brakes on this negative development in the short term if we work together, both the public and the health care industry. Apart from over prescription, this deals with everything from simple things like how to treat injuries on a football team and staying home when you’re sick, to hygiene in intensive care,” says Hanberger.

However in comparison to the rest of the Scandinavian countries and the Netherlands, Sweden is in a class by itself. Within the EU, where 25,000 people yearly are estimated to die as a result of infections that cannot be treated owing to resistance, many glance northward with no small amount of jealousy.

“In the long term, we have to realise we live in a global society. We have to arrive at international conventions. The World Health Organization (WHO) has awakened slowly. Now there are a handful of organisations working on the issue, like the ReAct network chaired by Swedish researcher Otto Cars.”

Hanberger points to three things that must be stopped first of all:

Unrestricted sales

Processing of cattle that encourages growth

Discharge into watercourses

Recently, there have been alarming reports of how discharges from medicine factories in India have drastically increased the resistance of bacteria in the environment. The risk that their genes will be spread to disease-causing bacteria is immediate.

“Unfortunately, there is no reverse gear in the system. Bacteria stock that has developed resistance will remain, to a great extent. Our hope, however, is that bacteria that are sensitive to antibiotics can, in the long run, out-compete the resistant ones.

Text: Åke Hjelm

RESISTANCE – A QUESTION OF SURVIVAL

It is a natural biological reaction for an organism to develop strategies for survival in a hostile environment. In the case of bacteria, it is a question of a combination of genetic and biochemical mechanisms, for example

Spontaneous changes in the genome (mutations or strengthening of genetic expressions)

Transfer of genes from one bacterium to another

This is how bacteria can neutralise an antibiotic:

Structural changes that prevent the preparation from binding to targets in the bacterium’s cell

Changes in the cell wall prevent the antibiotic from penetrating the cell wall

Inactivation through enzymatic breakdown

Pumping the antibiotic out of the bacteria cell

Over the last 30 years, only a handful of new antibiotics have been released on the market. The economic incentive has tapered off, since the sales of any new preparation must be as low as possible. Strategies for entirely new medicines cover things like antibodies, antibacterial peptides, and bacteriophages (viruses that attack bacteria).

One in every three people who have picked up a resistant “superbacteria” still retains them even after several months of treatment. They come from water and food during trips abroad, but also from imported food.

Beware of vegetables that are not boiled, only washed!
In an effort to drive research forward, the ABR@LiU network has been started, with Professor Håkan Hanberger (pictured) as the contact person. In Autumn 2011, it will cover some 20 researchers and doctoral students from different research departments at the Department of Clinical and Experimental Medicine.